Application effect of bedside contrast-enhanced ultrasound combined with gas-water alternating injection method in severe patients with nasointestinal catheterization

doi:10.11958/20242255

Abstract

Abstract:

Objective To observe the application effect of bedside contrast-enhanced ultrasound combined with gas-water alternating injection method in severe patients with nasointestinal catheterization. Methods A total of 150 severe patients who were admitted to intensive care unit (ICU) and emergency intensive care unit (EICU) and required nasointestinal catheterization were collected. Patients were separated into the blind insertion method group (catheterization without other auxiliary equipment, n=50), the ultrasound method group (ultrasound-guided catheterization, n=53), and the combined method group (bedside contrast-enhanced ultrasound combined with gas-water alternating injection method, n=47) according to the wishes of patients or their families. The catheterization success rate, feeding standard-reaching rate within one week, catheterization time and incidence of adverse events were compared between three groups. Kappa test was used to compare the consistency of three methods with X-ray examination results after catheterization. Receiver operating characteristic (ROC) curve was used to evaluate the catheterization effect. Results The catheterization success rate and the feeding standard-reaching rate within one week were increased successively in the blind insertion method group, the ultrasound method group and the combined method group, and the catheterization time shortened in turn (P < 0.05). The consistency of blind insertion method, ultrasound method, combined method with X-ray examination was strong (Kappa=0.730), very strong (Kappa=0.835) and very strong (Kappa=0.911), respectively. Results of ROC curve showed that the areas under the ROC curve of the blind insertion method group, the ultrasound method group and the combined method group increased in turn, which were 0.838 (95%CI: 0.661-1.000), 0.918 (95%CI: 0.763-1.000) and 0.988 (95%CI: 0.959-1.000), and the combined method group had the best catheterization effect. There were no significant differences in the incidence of adverse events such as hiccup, abdominal distension, diarrhea, aspiration and gastrointestinal bleeding between the three groups (P > 0.05). Conclusion Bedside contrast-enhanced ultrasound combined with gas-water alternating injection method can improve the success rate of nasointestinal catheterization in severe patients, shorten the catheterization time and without increasing the incidence of adverse events.

Key words: critical patient medical care, ultrasonography, tomography, X-ray, gas-water alternating injection method, nasointestinal catheter

CLC Number:

R445.1

Figures/Tables 6

References 22

[1]	阎小雨, 常志刚, 肖诗柔, 等. 重症病人代谢特点及营养支持策略[J]. 中华消化外科杂志, 2021, 20(5):574-578.
	YAN X Y, CHANG Z G, XIAO S R, et al. Metabolic characteristics of critically ill patients and nutrition support strategy[J]. Chinese Journal of Digestive Surgery, 2021, 20(5):574-578. doi:10.3760/cma.j.cn115610-20210403-00164.
[2]	历丽, 曹树明, 杨仲平, 等. 鱼胶原低聚肽对急诊复杂手外伤手术患者预后的影响[J]. 天津医药, 2024, 52(8):868-871.
	LI L, CAO S M, YANG Z P, et al. Effects of fish collagen oligopeptide on operative prognosis of patients with emergency complex hand trauma[J]. Tianjin Med J, 2024, 52(8):868-871. doi:10.11958/20231943.
[3]	张靖垚, 杨斯宁, 加佳, 等. 重症病人肠内营养实施新思考及实践[J]. 中华消化外科杂志, 2021, 20(11):1162-1166.
	ZHANG J Y, YANG S N, JIA J, et al. New insights and practice in enteral nutrition for critically ill patients[J]. Chinese Journal of Digestive Surgery, 2021, 20(11):1162-1166. doi:10.3760/cma.j.cn115610-20211012-00498.
[4]	廖利萍, 高英, 何琦, 等. 不同肠内营养方式对重型颅脑损伤患者代谢及预后的影响[J]. 中国中西医结合急救杂志, 2023, 30(3):343-347.
	LIAO L P, GAO Y, HE Q, et al. Clinical study of different enteral nutrition methods on metabolism and prognosis of patients with severe traumatic brain injury[J]. Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care, 2023, 30(3):343-347. doi:10.3969/j.issn.1008-9691.2023.03.019.
[5]	鞠佳雨. 经鼻空肠管与经鼻胃管行肠内营养对重症急性胰腺炎影响的Meta分析[D]. 四川: 西南医科大学, 2023.
	JU J Y. Meta-analysis of the effect of enteral nutrition by nasojejunal tube versus nasogastric tube in severe acute pancreatitis[D]. Sichuan: Southwest Medical University, 2023. doi:10.27215/d.cnki.glzyu.2023.000122.
[6]	何建三, 王帝, 承韶晖, 等. 导线型鼻肠管在重症患者中的应用[J]. 中国急救医学, 2021, 41(9):779-783.
	HE J S, WANG D, CHENG S H, et al. Application of wire-guided nasointestinal tube in critical patients[J]. Chinese Journal of Critical Care Medicine, 2021, 41(9):779-783. doi:10.3969/j.issn.1002-1949.2021.09.009.
[7]	任秋艳, 宋佳, 龚仕金, 等. 超声定位联合渐进式注水法在老年重症患者鼻肠管置管中的应用[J]. 中华老年病研究电子杂志, 2022, 9(2):27-30.
	REN Q Y, SONG J, GONG S J, et al. Application of ultrasound localization combined with water injection in nasointestinal tube placement in elderly patients with severe diseases[J]. Chinese Journal of Geriatrics Research(Electronic Editon), 2022, 9(2):27-30. doi:10.3877/cma.j.issn.2095-8757.2022.02.006.
[8]	张玲玲, 张伟, 王聪聪, 等. 床旁电磁导航下留置鼻肠管在特重度烧伤患者中的应用效果[J]. 中华烧伤与创面修复杂志, 2024, 40(6):557-563.
	ZHANG L L, ZHANG W, WANG C C, et al. Application effects of indwelling nasoenteric tubes under bedside electromagnetic navigation in patients with extremely severe burns[J]. Chinese Journal of Burns and Wounds, 2024, 40(6):557-563. doi:10.3760/cma.j.cn501225-20231010-00108.
[9]	陈璇, 区嘉欢, 蔡贤斌. GCS和FOUR量表对意识障碍程度及预后评价的比较[J]. 实用医学杂志, 2013, 29(13):2152-2154.
	CHEN X, OU J H, CAI X B. Comparison of GCS and FOUR scores in assessing the level of consciousness and prognosis in patients with impaired consciousness[J]. The Journal of Practical Medicine, 2013, 29(13):2152-2154. doi:10.3969/j.issn.1006-5725.2013.13.030.
[10]	张青, 王小亭, 张宏民, 等. 重症临床急性生理学及慢性健康状况系统评分与人工评分的比较[J]. 中华医学杂志, 2015, 95(39):3173-3175.
	ZHANG Q, WANG X T, ZHANG H M, et al. Score in APACHE Ⅱ derived from critical clinic information system is more accurate than artificial method[J]. National Medical Journal of China, 2015, 95(39):3173-3175. doi:10.3760/cma.j.issn.0376-2491.2015.39.004.
[11]	高俊祥, 多妍蓓, 宋硕宁, 等. 采用肠内营养支持的重症肺炎患者住院死亡风险因素分析[J]. 中华临床营养杂志, 2023, 31(3):129-137.
	GAO J X, DUO Y B, SONG S N, et al. Risk factors of in-hospital death in severe pneumonia patients receiving enteral nutrition support[J]. Chinese Journal of Clinical Nutrition, 2023, 31(3):129-137. doi:10.3760/cma.j.cn115822-20230509-00078.
[12]	梅名强. 鼻-空肠管肠内营养支持对重症急性胰腺炎患者临床结局和预后的影响:基于倾向评分匹配分析[D]. 四川: 西南医科大学, 2023.
	MEI M Q. Impact of naso-jejunal tube enteral nutrition support on clinical outcomes and prognosis in patients with severe acute pancreatitis:a propensity score-based matched analysis[D]. Sichuan: Southwest Medical University, 2023. doi:10.27215/d.cnki.glzyu.2023.000363.
[13]	亚洲急危重症协会中国腹腔重症协作组. 重症病人胃肠功能障碍肠内营养专家共识(2021版)[J]. 中华消化外科杂志, 2021, 20(11):1123-1136.
	Asian Association of Acute and Critical Care, Chinese Abdominal Critical Care Collaboration Group. Expert consensus on enteral nutrition for gastrointestinal dysfunction in critically ill patients (2021 edition)[J]. Chinese Journal of Digestive Surgery, 2021, 20(11):1123-1136. doi:10.3760/cma.j.cn115610-20211012-00497.
[14]	李伦超, 单凯, 赵雅萍, 等. 2018年欧洲肠外肠内营养学会重症营养治疗指南(摘译)[J]. 临床急诊杂志, 2018, 19(11):723-728.
	LI L C, SHAN K, ZHAO Y P, et al. 2018 European Society for Extraintestinal and Enteral Nutrition critical care nutritional therapy guidelines(excerpt)[J]. Journal of Clinical Emergency, 2018, 19(11):723-728. doi:10.13201/j.issn.1009-5918.2018.11.001.
[15]	薛艳杰, 王丹. 盲插鼻肠管法行鼻肠管肠内喂养对脑卒中后吞咽功能障碍患者营养状况及预后的影响[J]. 国际医药卫生导报, 2023, 29(19):2807-2810.
	XUE Y J, WANG D. Influence of nasoenteral feeding by blind insertion of nasoenteric tube on the nutritional status and prognosis in patients with dysphagia after stroke[J]. International Medicine and Health Guidance News, 2023, 29(19):2807-2810. doi:10.3760/cma.j.issn.1007-1245.2023.19.030.
[16]	熊盛, 廖甜, 肖勇洪. 超声在重力锤型鼻肠管置入中的应用价值[J]. 中国超声医学杂志, 2023, 39(4):425-428.
	XIONG S, LIAO T, XIAO Y H. Application value of ultrasound in the insertion of gravity hammer nasojejunal tube[J]. Chinese Journal of Ultrasound in Medicine, 2023, 39(4):425-428. doi:10.3969/j.issn.1002-0101.2023.04.019.
[17]	潘芳, 于晓琳. 超声引导下水气混合注射技术对ICU鼻肠管置入患者一次性置管成功率的影响[J]. 中华养生保健, 2024, 42(19):183-186.
	PAN F, YU X L. The effect of ultrasound-guided water air mixed injection technology on the success rate of one-time nasointestinal tube placement in ICU patients[J]. Chinese Health Care, 2024, 42(19):183-186. doi:1009-8011(2024)-19-0183-04.
[18]	万香玉, 潘月帅, 姜金花, 等. 超声引导联合水气混合注射法在急性重症胰腺炎患者鼻肠管置入中的应用[J]. 中国中西医结合急救杂志, 2021, 38(5):570-573.
	WAN X Y, PAN Y S, JIANG J H, et al. Application of ultrasonography combined with hybrid water-air injection for insertion of nasojejunal tubes in patients with acute severe pancreatitis[J]. Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care, 2021, 38(5):570-573. doi:10.3969/j.issn.1008-9691.2021.05.013.
[19]	邢小康, 李曼, 郭丰. 胃肠超声联合气水交替注射法对重症患者鼻肠管定位的价值[J]. 中华临床营养杂志, 2018, 26(6):349-353.
	XING X K, LI M, GUO F. Research on the application of gastrointestinal ultrasound combined with gas-water alternating injection in the positioning of nasointestinal tube for severe patients[J]. Chinese Journal of Clinical Nutrition, 2018, 26(6):349-353. doi:10.3760/cma.j.issn.1674-635X.2018.06.005.
[20]	BING X, YINSHAN T, YING J, et al. Efficacy and safety of a modified method for blind bedside placement of post-pyloric feeding tube:a prospective preliminary clinical trial[J]. J Int Med Res, 2021, 49(2):300060521992183. doi:10.1177/0300060521992183.
[21]	王春燕, 刘欢, 王金垚, 等. 超声引导下行鼻肠管置入法在危重症患者中的应用[J]. 广西医学, 2019, 41(16):2142-2143.
	WANG C Y, LIU H, WANG J Y, et al. Application of ultrasound-guided nasointestinal catheterization in critically ill patients[J]. Guangxi Medical Journal, 2019, 41(16):2142-2143. doi:10.11675/j.issn.0253-4304.2019.16.33.
[22]	米元元, 黄海燕, 尚游, 等. 中国危重症患者肠内营养治疗常见并发症预防管理专家共识(2021版)[J]. 中华危重病急救医学, 2021, 33(8):903-918.
	MI Y Y, HUANG H Y, SHANG Y, et al. Expert consensus on prevention and management of enteral nutrition therapy complications for critically ill patients in China(2021 edition)[J]. Chinese Critical Care Medicine, 2021, 33(8):903-918. doi:10.3760/cma.j.cn121430-20210310-00357.

组别		n	性别（男/女）	年龄/岁	BMI/（kg/m2）	GCS/分
盲插组		50	26/24	61.42±11.27	21.37±2.14	6.41±1.32
超声组		53	31/22	63.21±10.81	22.04±2.21	6.55±1.24
联合组		47	24/23	62.94±11.16	22.29±2.32	6.62±1.13
χ²或F			0.674	0.383	2.251	0.367
组别	病因（外伤/心肌梗死/ 脑卒中/肺炎/其他）			APACHE Ⅱ 评分/分	机械通气	应用镇静镇痛药物
盲插组	15/13/10/10/2			17.62±1.15	32（64.00）	34（68.00）
超声组	19/14/12/5/3			18.04±1.21	32（60.38）	34（64.15）
联合组	14/14/11/4/4			17.72±1.08	26（55.32）	28（59.57）
χ²或F	4.713			1.879	0.766	0.747

组别		n	性别（男/女）	年龄/岁	BMI/（kg/m2）	GCS/分
盲插组		50	26/24	61.42±11.27	21.37±2.14	6.41±1.32
超声组		53	31/22	63.21±10.81	22.04±2.21	6.55±1.24
联合组		47	24/23	62.94±11.16	22.29±2.32	6.62±1.13
χ²或F			0.674	0.383	2.251	0.367
组别	病因（外伤/心肌梗死/ 脑卒中/肺炎/其他）			APACHE Ⅱ 评分/分	机械通气	应用镇静镇痛药物
盲插组	15/13/10/10/2			17.62±1.15	32（64.00）	34（68.00）
超声组	19/14/12/5/3			18.04±1.21	32（60.38）	34（64.15）
联合组	14/14/11/4/4			17.72±1.08	26（55.32）	28（59.57）
χ²或F	4.713			1.879	0.766	0.747

组别	n		置管失败
组别	n		胃腔内盘绕	幽门部折返胃腔		十二指肠折返胃腔
盲插组	50		13（26.00）	5（10.00）		2（4.00）
超声组	53		6（11.32）	2（3.77）		1（1.89）
联合组	47		0（0.00）^a	0（0.00）		0（0.00）
χ²或F			14.939^＊	5.593		1.983
组别		置管成功			1周内喂养达标		置管时间/min
盲插组		30（60.00）			29（58.00）		32.41±3.45
超声组		44（83.02）^a			43（81.13）^a		29.42±3.21^a
联合组		47（100.00）^ab			46（97.87）^ab		27.23±2.82^ab
χ²或F		25.146^＊			23.247^＊		32.617^＊

组别	n		置管失败
组别	n		胃腔内盘绕	幽门部折返胃腔		十二指肠折返胃腔
盲插组	50		13（26.00）	5（10.00）		2（4.00）
超声组	53		6（11.32）	2（3.77）		1（1.89）
联合组	47		0（0.00）^a	0（0.00）		0（0.00）
χ²或F			14.939^＊	5.593		1.983
组别		置管成功			1周内喂养达标		置管时间/min
盲插组		30（60.00）			29（58.00）		32.41±3.45
超声组		44（83.02）^a			43（81.13）^a		29.42±3.21^a
联合组		47（100.00）^ab			46（97.87）^ab		27.23±2.82^ab
χ²或F		25.146^＊			23.247^＊		32.617^＊

组别	n	结果	X线片		Kappa
组别	n	结果	阳性	阴性	Kappa
盲插组	50	阳性	39（78.00）	3（6.00）	0.730^＊＊
盲插组	50	阴性	1（2.00）	7（14.00）	0.730^＊＊
超声组	53	阳性	45（84.91）	1（1.89）	0.835^＊＊
超声组	53	阴性	1（1.89）	6（11.32）	0.835^＊＊
联合组	47	阳性	40（85.11）	0（0.00）	0.911^＊＊
联合组	47	阴性	1（2.13）	6（12.77）	0.911^＊＊